Please check the details above before submitting your application as Sterling cannot be held responsible for monies released to incorrect bank details.

Name of bank:

Branch Name:

Swift Code/BIC Number:

Name of account holder:

Account number/IBAN:

Branch address:

Address Line 1:

Address Line 2:

Town/City:

County:

Area code:

Country:

Address of account holder:

Address Line 1:

Address Line 2:

Town/City:

County:

Area code:

Country:

Please note; non-UK bank account holders will incur an international bank charge imposed by our bank, plus a possible conversion charge per payment applied by your own bank. Unfortunately, these charges are beyond the control of Sterling Umbrella, Sterling Techserv & Sterling CIS.

3. UTR Details

Unique tax reference number (UTR):
(Sole traders only)

Account name:

Trading name:

Are you VAT registered?:
Yes:
No: If you answered yes, please provide a copy of your VAT registration certificate.

4. Agency Details

Agency name:

Branch location:

Contact telephone number:

Name of consultant:

Agency start date:

5. About the Assignment

Is the assignment?

UK based

Abroad

Offshore

How long will the assignment last?

0-3 Months

3-6 Months

6-9 Months

9 Months+

How would you classify the assignment?

Trade

Technical

Professional

Rail

Clerical

Medical

Education

6. Security Information

To ensure that your financial and personal details are only discussed with yourself, we require a security password.
We will request this each time you contact us. Your security password must be no more than 15 characters.

My chosen confidential password is:

Repeat password:

Mother's maiden name:

Town of birth:

Name of last school attended:

7. Next of Kin Details

Next of kin name:

Home telephone number:

Mobile number:

8. How did you hear about us?

Agency

Colleague/Workmate

Previously used us

Online

Communications (e.g. advertising)

9. Insurance

With Sterling Techserv you are covered by or Public Liability and Personal Accident Insurance.
Information relating to the cover, limitations and exclusions of each policy are available here.

10. Confirm you have downloaded and understood the Health and Safety handbook

"I acknowledge I have read and understand the contents of the Health and Safety handbook and agree to comply with the policies
and procedures contained within it."

Signed: By checking this box you are agreeing to the above statement.

date: 20/03/2018

If you wish for us to send you a paper copy, please tick here

11. Medical

General Medical Council (GMC)

PIN:

General Dental Council (GDC)

PIN:

Health and Care Professions Council (HCPC)

PIN:

Nursing and Midwifery Council (NMC)

PIN:

12. Contract for Services

We require confirmation that you have agreed to the Sterling Techserv Contract for Services.
You will have the opportunity to read the contract after submitting your registration form and self-employed assessment.
Upon agreeing to the terms, you will receive a confirmation e-mail with a copy attached for your records.

13. Eligibility to Work in the UK (ETW)

We require ETW documents to confirm you are eligible to work in the UK. Include one of the following with your registration:

Your original passport or a photocopy countersigned by a professional or manager. Countersigned passports must clearly show
the image, passport details and the signature. The person countersigning your passport copy must provide their full name, job
title and date of signature.

A national identity card photocopy countersigned by a professional or manager

If you do not have a passport and you are a British or Irish national please provide the following:

All data we hold about you and how we process and use it complies with the data protection act.
From time to time, we may offer services or products which we feel may benefit you through carefully selected third parties e.g.
accountancy services or mortgage advice.

15. Declaration

"I declare that the information I have provided is correct and I understand that it is my responsibility to inform Sterling Techserv of
any changes to my job title, personal, bank or agency details as soon as possible. I also understand that if I have provided details that
relate to an account not held in my name, e.g. spouse, and the relationship between the account holder and myself breaks down,
Sterling Techserv cannot be held responsible for any payments to the nominated account. I also agree to the terms and conditions
set in the contract for services."

Signed: By checking this box you are agreeing to the above statement.

date: 20/03/2018

Supporting Documents

Please could you upload documentation for the following:

Evidence of eligibility to work in the UK (see section 13 above for further details)

Copies of any professional qualifications held (applicable to your current job)

Copy of VAT registration certificate (if VAT registered)

If you do not have electronic copies of the above documentation, we will require paper copies.
Please return these either by